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      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Risks of harm with cannabinoids, cannabis, and cannabis-based medicine for pain management relevant to patients receiving pain treatment: protocol for an overview of systematic reviews

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          Abstract

          Supplemental Digital Content is Available in the Text.

          Abstract

          Introduction:

          With the increasing availability of cannabis and cannabinoids and their potential utility for pain treatment, there is a growing need to evaluate the risk-benefit considerations of cannabinoids for the management of pain. As part of the IASP Cannabis and Cannabinoids Task Force, this protocol describes a planned overview of systematic reviews summarizing the risks of harm with cannabinoids that are relevant to patients receiving pain treatment.

          Methods:

          This overview will involve literature searches of several databases and a defined search strategy that will target systematic reviews or meta-analyses of cannabinoids where harms are the primary focus. Data extraction will include various features of the cannabinoid(s) and the harm(s) being studied as well as other methodological features of each included systematic review. Methodological quality of each included review will be assessed using AMSTAR-2 as well as compliance with the PRISMA harms checklist. Prospero registration pending.

          Discussion:

          The broad overview of reviews defined by this protocol is expected to synthesize available good quality evidence of harms that will help inform risk-benefit considerations about the use of cannabinoids for pain management.

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          Most cited references23

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          • Article: found

          The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

          Andrew Kolodny, David T Courtwright, Catherine Hwang … (2015)
          Annual Review of Public Health, 36(1), 559-574
          Article 0 comments Cited 381 times – based on 0 reviews     Review now
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            Cardiovascular risk and inhibition of cyclooxygenase: a systematic review of the observational studies of selective and nonselective inhibitors of cyclooxygenase 2.

            Patricia McGettigan, David Henry (2006)
            Evidence that rofecoxib increases the risk of myocardial infarction has led to scrutiny of other nonsteroidal anti-inflammatory drugs (NSAIDs). Regulatory agencies have provided variable advice regarding the cardiovascular risks with older nonselective NSAIDs. To undertake a systematic review and meta-analysis of controlled observational studies to compare the risks of serious cardiovascular events with individual NSAIDs and cyclooxygenase 2 inhibitors. Searches were conducted of electronic databases (1985-2006), scientific meeting proceedings, epidemiological research Web sites, and bibliographies of eligible studies. Eligible studies were of case-control or cohort design, reported on cardiovascular events (predominantly myocardial infarction) with cyclooxygenase 2 inhibitor, NSAID use, or both with nonuse/remote use of the drugs as the reference exposure. Of 7086 potentially eligible titles, 17 case-control and 6 cohort studies were included. Thirteen studies reported on cyclooxygenase 2 inhibitors, 23 on NSAIDs, and 13 on both groups of drugs. Two people independently extracted data and assessed study quality with disagreements resolved by consensus. Data were combined using a random-effects model. A dose-related risk was evident with rofecoxib, summary relative risk with 25 mg/d or less, 1.33 (95% confidence interval [CI], 1.00-1.79) and 2.19 (95% CI, 1.64-2.91) with more than 25 mg/d. The risk was elevated during the first month of treatment. Celecoxib was not associated with an elevated risk of vascular occlusion, summary relative risk 1.06 (95% CI, 0.91-1.23). Among older nonselective drugs, diclofenac had the highest risk with a summary relative risk of 1.40 (95% CI, 1.16-1.70). The other drugs had summary relative risks close to 1: naproxen, 0.97 (95% CI, 0.87-1.07); piroxicam, 1.06 (95% CI, 0.70-1.59); and ibuprofen, 1.07 (95% CI, 0.97-1.18). This review confirms the findings from randomized trials regarding the risk of cardiovascular events with rofecoxib and suggests that celecoxib in commonly used doses may not increase the risk, contradicts claims of a protective effect of naproxen, and raises serious questions about the safety of diclofenac, an older drug.
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              Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes.

              L Scascighini, V Toma, S Dober-Spielmann … (2008)
              To provide an overview of the effectiveness of multidisciplinary treatments of chronic pain and investigate about their differential effects on outcome in various pain conditions and of different multidisciplinary treatments, settings or durations. In this article, the authors performed a systematic review of all currently available randomized controlled trials (RCTs) fulfilling the inclusion criteria, by using a recently developed rating system aimed to assess the strength of evidence with regard to the methodological quality of the trials. Compared with other non-disciplinary treatments, moderate evidence of higher effectiveness for multidisciplinary interventions was shown. In contrast to no treatment or standard medical treatment, strong evidence was detected in favour of multidisciplinary treatments. The evidence that comprehensive inpatient programmes were more beneficial that outpatient programmes was moderate. Fibromyalgia and chronic back pain patients tended to profit more substantially than patients with diverse origins or chronic pain diagnoses. No evidence was found that treatment variables, such as duration or programme components, were influential for the success of the intervention. A standard of multidisciplinary programmes should be internationally established to guarantee generally good outcomes in the treatment of chronic pain. Our results highlight the lack of quality of design, execution or reporting of many of the RCTs included in this article. Future studies should more specifically focus on differential effects of treatment components and patient variables, allowing the identification of subgroups, which most probably would profit from multidisciplinary pain programmes.
              Article 0 comments Cited 155 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pain Rep
                Journal ID (iso-abbrev): Pain Rep
                Journal ID (coden): PAIREP
                Journal ID (publisher-id): Painreports
                Title: Pain Reports
                Publisher: Wolters Kluwer (Philadelphia, PA )
                ISSN (Electronic): 2471-2531
                Publication date Collection: May-Jun 2019
                Publication date (Electronic): 29 May 2019
                Volume: 4
                Issue: 3
                Electronic Location Identifier: e742
                Affiliations
                [a ]Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
                [b ]Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
                [c ]School of Policy Studies, Queen's University, Kingston, ON, Canada
                [d ]University of Sydney Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, New South Wales, Australia
                [e ]National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
                [f ]Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
                [g ]National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London, Maudsley NHS Foundation Trust, King's College London, London, United Kingdom
                [h ]South London and Maudsley NHS Mental Health Foundation Trust, London, United Kingdom
                [i ]Centre for Pain Research, The University of Bath, Bath, United Kingdom
                [j ]Division of Clinical and Translational Research, Department of Anesthesiology, Washington University Pain Center, Washington University School of Medicine, St Louis, MO, USA
                [k ]Nuffield Department of Clinical Neurosciences, University of Oxford, Pain Research, The Churchill, Oxford, United Kingdom
                [l ]Pain Research Group, Department Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
                [m ]Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
                Author notes
                [* ]Corresponding author. Address: Department of Anesthesiology & Perioperative Medicine, Victory 2 Pavillion, 76 Stuart Street, Kingston, Ontario, Canada, K7L2V7. Tel.: 1-613-548-7827. E-mail address: gilroni@ 123456queensu.ca (I. Gilron).
                Article
                Publisher ID: PAINREPORTS-D-19-0033 Accession ID: 00002
                DOI: 10.1097/PR9.0000000000000742
                PMC ID: 6749892
                SO-VID: 0490f326-4b5f-4083-8022-c39f847ad881
                Copyright © Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.
                License:

                This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0 (CC BY-ND) which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

                History
                Date received : 07 February 2019
                Date revision received : 06 March 2019
                Date accepted : 09 March 2019
                Categories
                Subject: 12
                Subject: Pharmacology
                Subject: Research Protocol
                Custom metadata
                OPEN-ACCESS TRUE
                SDC T

                Keywords: cannabis,cannabinoids,harms,adverse events,adverse effects,pain management,clinical trials
                Data availability:
                Keywords: cannabis, cannabinoids, harms, adverse events, adverse effects, pain management, clinical trials

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